What’s the CAGE Assessment?

Medically Reviewed by Carol DerSarkissian, MD on July 10, 2023

• What Is Substance Abuse?
• CAGE Assessment and Diagnosing Substance Abuse
• CAGE Questionnaire
• After the CAGE Assessment

The CAGE Assessment (also called the CAGE Questionnaire) is a preliminary test. It’s a set of questions that are used to show you may have a substance abuse dependency in adults.

The letters CAGE stand for Cut, Annoyed, Guilty, and Eye, based on the questions that can help tell if you have a substance abuse problem.

It was first developed to show people they may have an alcohol abuse problem. Many versions have now been adapted to also identify dependency on drugs. Sometimes, the test may be called a CAGE-AID if it is to identify a problem with drug abuse.

The CAGE Assessment is for regular drug users. Occasional drug users who answer the questionnaire likely won’t receive accurate results.

What Is Substance Abuse?

Substance abuse disorder, substance dependence, and substance addiction are disorders. They affect your brain, leading to a lack of control over drugs or medications.

‌The topic of substance abuse is complex. The symptoms and risks posed by substance abuse depend on the type of substance and the user. However, substance abuse is harmful and requires intervention. ‌

Effects of substance abuse. Substance abuse becomes apparent when the substances start causing harm or distress. This can include physical symptoms, problems at work or school, and struggles in relationships.

‌Commonly abused substances. Many substances can be the cause of abuse.

Common illegal substances that are abused include:

• Heroin
• Cocaine
• Methamphetamine

The common legal substances that are abused are:

• Alcohol
• Cannabis (legality is state-dependent)
• Nicotine
• Prescription medications

Causes of substance abuse. Culture, society, and your environment are powerful factors that may cause a substance abuse problem. Mental health disorders, genetics, and personality also heavily influence your susceptibility to developing a substance dependency.

Symptoms of a substance dependency. It’s not always easy for the user to see their symptoms. You answer the CAGE questionnaire as a substance user to see if your actions or symptoms may show you may have a problem.

Some of the actions and symptoms of a substance abuser are:

• Frequently using substances more or longer than intended
• Repeatedly and unsuccessfully trying to lessen substance use
• Spending too much time getting, using, and recovering from substances
• Having strong cravings for your preferred substance
• Frequent substance use that interferes with daily activities like school or work
• Letting your relationships be affected by your substance use
• Using substances at the expense of your physical or mental health
• Displaying an increased tolerance, requiring more of the substance for the same effects
• Experiencing withdrawal symptoms

CAGE Assessment and Diagnosing Substance Abuse

The CAGE Assessment is a personal assessment for substance abuse. It’s not a formal diagnosis. It’s simply a preliminary assessment. Formal diagnosis requires a thorough assessment and evaluation by your doctor.

CAGE Questionnaire

The CAGE acronym represents keywords present in each question. It stands for:

The questions represented by the CAGE acronym are:‌

1. Have you ever felt you should “cut” down on your substance use?
2. Have people “annoyed” you by criticizing your substance use?
3. Have you felt bad or “guilty” about your substance use?
4. Have you ever used a substance first thing in the morning to steady your nerves or start the day (an “eye” opener)?

Your answers will indicate a possible substance abuse problem. Typically, answering “yes” to two or more questions suggests you may have a substance dependency.‌‌

After the CAGE Assessment

If you personally assess yourself using the CAGE questionnaire and find that you may have a substance dependency, what do you do next? ‌

Talk to your doctor. Your doctor can recommend evaluation by a psychiatrist, psychologist, or drug counselor. They will then work with you on an effective treatment plan.

Treatment will vary. Exact treatment plans will depend on your own medical history, mental health, and the substances that were used. Other factors that affect your treatment plan include:

• Age
• The severity of your symptoms
• The severity of your dependence‌

Regardless of those factors, most treatment plans contain the following:

• Therapy sessions, including individual, group, or family sessions
• An understanding of addiction
• How to be drug-free
• How to prevent relapse

Detox programs. These detoxification programs allow you to stop using substances quickly and safely. During this time, you’re gradually weaned off the substance or substances.

You’ll likely take part in withdrawal therapy during a detox program. For more severe cases, you may need to be admitted into a hospital or treatment center to be monitored and ensure your safety.

Behavior therapy. Substance abuse treatment programs often involve behavior therapy. A licensed substance abuse counselor helps you develop methods to:

• Handle substance cravings
• Avoid substances
• Prevent relapses
• Handle a relapse if it occurs
• Talk about any complications with your job, relationships, or legal bodies
• Address possible mental health disorders‌

Self-help groups. Many support groups use a step-based program that leads you through the steps of sobriety. There are a variety of self-help groups that can help you with your specific circumstance. ‌

For example, Alcoholics Anonymous works with people dependent on alcohol. Narcotics Anonymous helps those addicted to drugs.

If you or someone you know has a substance dependency, you can call the Substance Abuse and Mental Health Services Administration's National Hotline at 1-800-662-HELP (4357).